Provider Demographics
NPI:1174627269
Name:OBREGON, JACINTO GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JACINTO
Middle Name:GARCIA
Last Name:OBREGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11136 WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-403-4536
Mailing Address - Fax:708-403-4537
Practice Address - Street 1:535 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5076
Practice Address - Country:US
Practice Address - Phone:815-398-0175
Practice Address - Fax:815-398-9587
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060097208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036060097Medicaid
P00288070OtherPALMETTO GBA RR MEDICARE
ILK09352Medicare PIN
C45103Medicare UPIN